Tell Me About You
Email address *
Date of filling out questionnaire *
MM
/
DD
/
YYYY
Name
Your answer
Birthdate
Your answer
List any health concerns/conditions that you are experiencing: *
Diabetes, high blood pressure, joint pain or other injuries that will affect your ability to exercise
Describe your biggest challenge/struggle in the past when it comes to reaching your health and wellness goals. (Nutrition, motivation, time to exercise, work schedule, no family/friend support) *
Your answer
What is your primary reason to get healthier? *
Required
List your most important attainable goal that you would like to achieve in the next 30 days. *
(Make it measurable and specific for the 30 day time period)
Your answer
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